Reflective Essay on Acutely ill Patient Mrs Smith

Reflective Essay on Acutely ill Patient Mrs Smith This essay will be a reflective essay focussing on a critical incident that took place whilst being at practice placement earlier in the year. A critical incident is defined as a learning technique that breaks an event down into its main components for the purpose of reflective analysis (Hoystonard, and Simpson, 2004) The essay will give a critical analysis of an event with an acutely ill adult and will use Gibbs model of reflection (1988) to do so. For the purpose of this essay, the patient will be referred to as Mrs Smith. The reflective model I have chosen to use is Gibbs model of reflection (1988). Gibbs model of reflection incorporates the following: description what happened?, feelings what were you feeling?, evaluation what was good or bad about the experience?, analysis what sense can be made of the situation?, conclusion what else could you have done?, and an action plan if the situation arises again what would you do?. The model will be applied to the essay to facilitate critical thought, relating theory to practice where the model allows. This incident occurred in the middle of my 10 week placement on the ward. My reason for using this critical incident is because of the impact that it had on me. I did not expect to see my mentor in a situation which she did not appear to be able to cope with, principally through lack of communication. Mrs Smith is a 46 year old lady suffering from acute myeloid leukaemia (AML). In order to provide treatment for this disease, it was decided that a Hickman line would be the most appropriate type of access for the patient, so this procedure was performed in theatre under sterile conditions. Mrs Smith was well enough to go home just a few hours after the procedure but started to feel unwell the following morning. She was experiencing extreme pain at the wound site so returned to hospital. When Mrs Smith returned to the ward it was clear this event was serious as her neck and chest were very red and inflamed looking and she was showing all the signs and symptoms of a severe infection, i.e. temperature of 38+C, heart rate greater than 90 beats per minute, respiratory rate greater than 20 breaths per minute and white blood cell count greater than 12,000. These combined symptoms are known as the Systemic Inflammatory Response Syndrome. This, in conjunction with a confirmed infection is kn own as Sepsis. My mentor and I immediately began the process of managing the infection, keeping Mrs Smith stable and preventing further deterioration in her condition. Although we managed to prevent Mrs Smith from progressing to septic shock, I felt the management of the situation could have been handled better by my mentor, enabling me to provide better care. This is the issue which I would like to reflect on. My thoughts and feelings towards this event were initially fear ,as I had not dealt with such a seriously ill patient before and I was worried that my mentor would expect more from me than I was capable of giving. I felt under pressure as things had to be done quickly and I did not want my mentor to think I was not capable in a critical situation. I also did not want the patient to feel that I was not able, and that she was not in safe hands. Durbin (2004) has said that critically ill patients may experience many unpleasant and frightening events, so the use of reassuring mannerisms and honest communication improves patient comfort. My mentor started to become flustered and was not staying calm which was what was needed in this situation. I felt that procedures were being rushed and not done as well as they could have been owing to the pressure of the situation. My mentor was trying to do everything herself and not communicating with either myself, the patient or other staff members, causing uncertainty and confusion. Houston (2009) states that keeping calm under pressure will enable you to make good decisions, have a better judgement, and be able to deal with patients and their families better. I was trying to think and plan ahead for Mrs Smiths care but knew I was not achieving this because of the lack of communication from my mentor. I wanted to ask my mentor to calm down as it was not helping the situation, and I imagined that it was making the patient feel worse and more anxious seeing this lack of control from the nursing staff who were supposed to be helping her. Mrs Smith just needed to be reassured and kept calm during this initial crucial hour, but I could see that we had not achieved this and she looked very worried. McCabe (2003) states that patient-centred communication is vital to encourage and support both nurse and patient in a critical situation and Radcliffe (2006) is a firm advocate of improving communication with patients . As blood cultures and urine samples were taken and the administering of antibiotics began, the patient eventually stabilised and vital signs began to improve which was a great relief as we both now felt more in control of the situation. It was not until then that my mentor began to deliver better care and I started to plan ahead for what would be needed next. Gillie and Thorman (2008) state that having a positive attitude will let you be more in control of a critical situation, and that being positive shows you have the strength to stand up to a negative situation. I did not go into this event with a positive attitude as I had never experienced this before and initially just felt panicked and under pressure. However, in future I will always have a positive attitude when going into a new and difficult situation as it will have a greater effect and better outcome for all involved. Mrs Smith was now being managed for sepsis and my mentor had removed the source of infection which was proven to be the Hickman line, and inserted a urinary catheter to monitor Mrs Smiths urinary output as she had not passed urine at all that day. She was given IV fluids to maintain her circulating volume and I continued to monitor her vital signs and assess Mrs Smiths mental state. The antibiotic therapy should have been started earlier, but owing to my mentor not contacting the doctor quickly enough, this delayed the patient being stabilised quicker. If my mentor had remained calmer then she would have been more focussed on what was a priority. Prioritising what has to be done first, is an essential skill nurses need in order to provide a good level of nursing care, Castledine (2002). I felt this was a negative aspect of my experience as I knew myself that we had not prioritised and that antibiotic therapy should be started shortly after diagnosis of sepsis to prevent further deter ioration. However, positive aspects of the experience were that I learned that I was calm under pressure and was able to reassure the patient when I did not think I could. Another positive aspect was that my mentor and I managed to control the sepsis before the patient went into septic shock. She was however, already showing signs of severe sepsis as her kidney function had altered. On looking back and analysing the situation, it was a worthwhile exercise as it was a good learning curve for me on how not to act in a critical situation. I did not want to be like my mentor who was flustered and panicking and therefore not thinking properly, as I saw how it affected the situation. Because of this critical incident occurring, I learnt valuable skills that I will use in other situations, should they arise. Skills such as, staying calm and not panicking, communicating with the patient to reassure them they will be ok and communicating with relatives as they need to know what is going on as well. Acting quickly under pressure, but not too quickly which may cause mistakes to happen. Also, very importantly, to ask for help when required. If this situation was to happen again, I feel I am more prepared and would not have the initial feeling of worry and fear, as I know what to expect and am capable of carrying out what may be asked of me. On making sense of the situation, I realise I am more confident now not only in this situation but other tasks that are asked of me in the practice placement. This incident began as what should have been a straightforward case of managing sepsis, but soon turned into a worrying case of possible severe sepsis and losing control of this situation all down to panic, lack of forward planning and lack of communication. Robson and Daniels (2008) discuss how the Sepsis Six Bundle could have been used in this situation, as it has been introduced in 2007 for cases exactly like this, reducing mortality rates by 25%. Six simple steps to be followed within the first hour and severe sepsis will be avoided. Mitchell et al (2004) looks at the changes made to the patients care if sepsis is managed well and how one of the roles of the nurse in this situation must be to keep the patient reassured as much as possible. Reassurance would have kept Mrs Smith from becoming more panicked and would have made the event slightly easier for myself and my mentor. Once the initial hour had passed and the management of the sepsis was under control, Mrs Smith became more stable and was relieved to have her pain under control. After a few days on a course of antibiotics, Mrs Smiths infection soon cleared. On reflection, I now know what was good and bad about this event and what to take from it. If a situation like this were to occur again, the first thing to apply would be a positive attitude leading to a more controlled and calmer management of a critical incident. Being more in control of the situation makes forward planning easier to do and better nursing care can be achieved. The patient would benefit greatly and a lot more quickly than a rushed, uncontrolled environment. Fewer mistakes would occur and simple tasks would not be missed as the nurse involved would be more focussed. Proper communication is a huge factor in how any incident turns out. Anderson (2009) states that breakdown in communication can cause negative outcomes, and warns about poor communication, especially with patients and their families. Lack of communication can lead to lack of trust and mean that any future communications could well be disregarded. Egan (2007) states that the face and body are very communicative and in this situation the patient was picking up my mentors uncertainty and panic eve n through her non-verbal communication, making her worried and ill at ease. McCabe and Timmons (2006) stress how important communication is in establishing rapport with the patient, again building up trust. Coulehan et al (2001) also note how communication, using empathy helps to establish a relationship with both patient and relatives. In a future situation I would ensure proper communication with all involved especially the patient, to put them at ease and reassure them that the staff knows what they are doing. Now that I have had this experience and learnt from it, I have gained a lot more confidence in how to better manage a patient in a similar situation, not just a critical incident. Being more confident lets the patient know that you are in control and can put their mind at ease, Penzien and Rains (2007). I would know not to show fear, as there was not anything to fear and the last thing the patient needed was to feel worried she was not in safe hands.

Marriage in Jane Austen’s Pride and Prejudice Essay

The intricate nexus of marriage, money and love in Jane Austen’s society is unfolded through the development of plots and characters of her novel Pride and Prejudice. In the nineteenth century’s rural England, marriage was a woman’s chief aim, both financially and socially. Financially because of women’s dependent position marriage was the â€Å"only honourable position†, infinitely preferable to the dependence of precarious shabby-genteel spinsterhood. Money was, therefore, a very significant aspect of Austen’s society, especially when marriage was concerned. â€Å"A single man of large fortune† was naturally considered as â€Å"a nice thing† for the unmarried girls. Partners were chosen for what might now seem unemotional reasons: fortune and connections, similar to, but preferably better than one’s own. By representing a series of marriages, Austen in this novel unearths and elucidates different aspects of the role of marriage, money and love in her society. Austen was a realist and painted her time as they were. In this novel, love and money-based Darcy-Elizabeth marriage is the most successful one whereas the marriage of Elizabeth’s parents, Mr. and Mrs. Bennet, is one of the faulty ones. Mr. Bennet married his wife being â€Å"captivated† and tempted by her â€Å"youth, beauty† and physical appearance. He forgot that the first appeal of a pretty face does not last long unless serenity of mind and sweetness of temper provide more enduring powers of attraction. Moreover, Mrs. Bennet inherited no property. So, form every point of view, this marriage is a failure. Mr. Bennet, therefore, always has to endure her â€Å"weak understanding†, vulgarity to such and extreme degree that he has nothing to revel in except confining himself to his library all the day, and thus eluding the necessary rituals of family and society. Charlotte’s loveless matrimony for financial security with the pompous Collins is another interesting marriage. Being twenty-seven and plain looking and realizing that it is her last chance, she accepts the grotesque Mr. Collins, to whom the role of romance and love in life is beyond the reach. He only wants a wife, because in the eyes of the society it is time for him to settle and be married. Charlotte knows that apart from some kind of security and happiness, marriage gives a woman a position. She has few hopes of happiness in marriage beyond the material comfort it can give and so she marries Collins who is inferior in intelligence, only for the ‘home and position’ he offers, as she believes â€Å"Happiness in marriage is entirely a matter of chance†. The marriage and money theme operates in a baffling way when Elizabeth herself comes to marry. When she sees Pemberly, her ‘prejudice’ against Darcy begins to be ‘subdued’ and later by accepting him she makes the most glorious match of and of Austen’s heroines. The fact that Darcy has then thousand pounds a year is not to be ignored; it emphasizes the perfect adjustment between personal and social ambition achieved by Elizabeth. [Actually Jane Austen understood better than any other of her contemporary English novelists the degree to which social and personal behaviors and even emotion depend on the economic framework of the society.] Moreover, in her marriage with Darcy, affection and understanding, financial security and social engagement are juxtaposed. But to achieve all these material things she has never turned herself into a â€Å"husband-hunting butterfly† despite her mother’s inducement. Although she is aware of the fact that in her society a senile spinster, without any fortune, is faced with the prospect of a bleak future full of deprivation and humiliation, still she is the bold heroine who at first showed courage to refuse two marriage proposals. To Austen, sexuality was far less vital to relationships than its counterpart, affection. Therefore, Lydia’s ex-based marriage with the seductive but penniless Wickham later turns out to be an unsuccessful ones. Wickham’s plausible appearance even overwhelmed Elizabeth once. His former interest in Miss King and her â‚ ¤ 10,000 dowry alludes to the role of money in marriage. He only takes Lydia to London only for physical enjoyment. As a consequence, their marriage ends in his going â€Å"to enjoy himself in London† and Lydia’s patent failure in managing her household financially despite Darcy and Elizabeth’s continuous help. The Bingley-Jane marriage is another example of good marriage, like the Darcy- Elizabeth marriage, where mutual understanding, romance and financial  stability are combined. Their affection-based marriage works as both are perfectly amiable, modest and gentle. The established marriage of the Gardiners is too shadowy to have a dramatic role. We are only dimly aware of it as a satisfactory relationship between two apparently similar type of persons. In â€Å"Pride and Prejudice† we experience different marriages in the light of one another. Austen presents all the material for an al-round understanding and view: Jane and Elizabeth, combing love and marriage, Charlotte marries for safety, Lydia repenting at leisure. The married couples are equally varied, from well-matched like the Gardiners to ill-suited like the Bennets. The novel says in effect that the real object of love and marriage is not only financial security or physical passion or romance, but also the self-development that true relationships bring about. A marriage can only become an institution when it provides for the fulfillment of both men and women’s aspirations, sanctified by love and validated by prudence that both Elizabeth Bennet and Mr. Collins can live on, the former drinking deep draughts of life’s fullness, the later continuing to sip its littleness. The richness of Pride and Prejudice lies in that exploration of life and marriage by Jane Austen.

Common Animal Questions and Answers

The animal kingdom is fascinating and often inspires a number of questions from both the young and old. Why do zebras have stripes? How do bats locate prey? Why do some animals glow in the dark? Find answers to these and other intriguing questions about animals. Why Do Some Tigers Have White Coats? Researchers from Chinas Peking University have discovered that white tigers owe their unique coloration to a gene mutation in the pigment gene SLC45A2. This gene inhibits the production of red and yellow pigments in white tigers but does not appear to alter black. Like orange Bengal tigers, white tigers have distinctive black stripes. The SLC45A2 gene has also been associated with light coloration in modern Europeans and in animals such as fish, horses, and chickens. The researchers advocate for the possible reintroduction of white tigers into the wild. Current white tiger populations only exist in captivity as wild populations were hunted out in the 1950s. Do Reindeer Really Have Red Noses? A study published in the BMJ-British Medical Journal reveals why reindeer have red noses. Their noses are abundantly supplied with red blood cells through the nasal microcirculation. Microcirculation is the flow of blood through tiny blood vessels. Reindeer noses have a high density of blood vessels that supply a high concentration of red blood cells to the area. This helps to increase oxygen to the nose and to control inflammation and regulate temperature. The researchers used infrared thermal imaging to visualize the reindeers red nose. Why Do Some Animals Glow In the Dark? Some animals can emit light naturally due to a chemical reaction in their cells. These animals are called bioluminescent organisms. Some animals glow in the dark to attract mates, to communicate with other organisms of the same species, to lure prey, or to expose and distract predators. Bioluminescence occurs in invertebrates such as insects, insect larvae, worms, spiders, jellyfish, dragonfish, and squid. How Do Bats Use Sound to Locate Prey? Bats use echolocation and a process called active listening to locate prey, typically insects. This is particularly helpful in clustered environments where sound can bounce off of trees and leaves making it more difficult to locate prey. In active listening, bats adjust their vocal cries emitting sounds of variable pitch, length, and repetition rate. They can then determine details about their environment from the returning sounds. An echo with a sliding pitch indicates a moving object. Intensity flickers indicate a fluttering wing. Time delays between cry and echo indicate distance. Once its prey has been identified, the bat emits cries of increasing frequency and decreasing duration to pinpoint its preys location. Finally, the bat emits what is known as the final buzz (rapid succession of cries) before capturing its prey. Why Do Some Animals Play Dead? Playing dead is an adaptive behavior used by a number of animals including mammals, insects, and reptiles.  This behavior, also called thanatosis, is most often employed as a defense against predators, a means to catch prey, and as a way of avoiding sexual cannibalism during the mating process. Are Sharks Color Blind? Studies on shark vision suggest that these animals may be completely color blind. Using a technique called microspectrophotometry, researchers were able to identify cone visual pigments in shark retinas. Of the 17 shark species studied, all had rod cells but only seven had cone cells. Of the shark species that had cone cells, only a single cone type was observed. Rod and cone cells are the two main types of light sensitive cells in the retina. While rod cells can not distinguish colors, cone cells are capable of color perception. However, only eyes with different spectral types of cone cells can distinguish different colors. Since sharks appear to have only a single cone type, it is believed that they are totally color blind. Marine mammals such as whales and dolphins also have only a single cone type. Why Do Zebras Have Stripes? Researchers have developed an interesting theory as to why zebras have stripes. As reported in the Journal of Experimental Biology, zebras stripes help to ward off biting insects such as horseflies. Also known as tabanids, horseflies use horizontally polarized light to direct them toward the water for laying eggs and to locate animals. The researchers state that horseflies are more attracted to horses with dark hides than those with white hides. They concluded that the development of white stripes prior to birth helps to make zebras less attractive to biting insects. The study indicated that the polarization patterns of reflected light from zebra hides were consistent with stripe patterns that were least attractive to horseflies in tests. Can Female Snakes Reproduce Without Males? Some snakes are capable of reproducing asexually by a process called parthenogenesis. This phenomenon has been obeserved in boa constrictors as well as in other animals including some species of shark, fish, and amphibians. In parthenogenesis, an unfertilized egg develops into a distinct individual. These babies are genetically identical to their mothers. Why Dont Octopuses Get Tangled in Their Tentacles? Hebrew University of Jerusalem researchers have made an interesting discovery that helps answer the question of why an octopus doesnt get tangled up in its tentacles. Unlike in the human brain,  the octopus brain does not map out the coordinates of its appendages. As a result, octopuses dont know where their arms are exactly. To prevent the octopuss arms from grabbing the octopus, its suckers will not attach to the octopus itself. The researchers state that an octopus produces a chemical in its skin that temporarily prevents the suckers from grabbing. It was also discovered that an octopus can override this mechanism when necessary as evidenced by its ability to grab an amputated octopus arm. Sources: Cell Press. White tiger mystery solved: Coat color produced by single change in pigment gene. ScienceDaily. ScienceDaily, 23 May 2013. (www.sciencedaily.com/releases/2013/05/130523143342.htm).BMJ-British Medical Journal. Experts discover why Rudolphs nose is red. ScienceDaily. ScienceDaily, 17 December 2012. (www.sciencedaily.com/releases/2012/12/121217190634.htm).Chanut F (2006) The Sound of Dinner. PLoS Biol 4(4): e107. doi:10.1371/journal.pbio.0040107.Springer ScienceBusiness Media. Are sharks color blind?. ScienceDaily. ScienceDaily, 19 January 2011. (www.sciencedaily.com/releases/2011/01/110118092224.htm).The Journal of Experimental Biology. How the zebra got its stripes. ScienceDaily. ScienceDaily, 9 February 2012. (www.sciencedaily.com/releases/2012/02/120209101730.htm).Cell Press. How octopuses dont tie themselves in knots. ScienceDaily. ScienceDaily, 15 May 2014. (www.sciencedaily.com/releases/2014/05/140515123254.htm).

The Monarchs Royal Assent

In Canada, royal assent is the symbolic final stage of the legislative process by which a bill becomes law.   History of Royal Assent The  Constitution Act of 1867 established that the approval of the Crown, signified by royal assent, is required for any bill to become law after passage by both the Senate and the House of Commons, which are the two chambers of Parliament. Royal assent is the final stage of the legislative process, and it is this assent that transforms a bill passed by both Houses of Parliament into law. Once royal assent has been given to a bill, it becomes an Act of Parliament and part of the law of Canada. In addition to being a required part of the legislative process, royal assent has strong symbolic significance in Canada. This is because royal assent signifies the coming together of the three constitutional elements of Parliament: the House of Commons, the Senate and the Crown.   The Royal Assent Process Royal assent may be given through a written procedure or through a  traditional ceremony, in which Members of the House of Commons join their colleagues in the Senate chamber. In the traditional royal assent ceremony, a representative of the   Crown, either the  governor-general of Canada  or a  Supreme Court justice, enters the Senate chamber, where the senators are in their seats. The  Usher of the Black Rod  summons members of the House of Commons to the Senate chamber, and members of both houses of Parliament witness that Canadians wish the bill to become law. This traditional ceremony must be used at least two times per year. The representative of the sovereign consents to the enactment of a bill  by nodding his or her head. Once this royal assent is officially given, the bill has the force of law, unless it contains another date on which it will go into effect. The bill itself is sent to Government House to be signed. Once signed, the original bill is returned to the Senate, where it is put into the archives.